Healthcare Provider Details

I. General information

NPI: 1336911205
Provider Name (Legal Business Name): LUIS DAVID VELASQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W SUNSET BLVD STE 610
LOS ANGELES CA
90027-5863
US

IV. Provider business mailing address

13120 PURCHE AVE
GARDENA CA
90249-1643
US

V. Phone/Fax

Practice location:
  • Phone: 323-671-2600
  • Fax:
Mailing address:
  • Phone: 310-694-1286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: